JİNEKOLOJİK ONKOLOJİ CERRAHİSİNDE HIPEC TEDAVİSİNİN YERİ

Öz

Birçok kanser abdomen ve pelvis içerisindeki organlardan kaynaklanmaktadır ve üç farklı yol ile yaylırlar. Bunlar; hematojen, lenfatik ve transçölemik yoldur. Çok sayıda hastada hastalık progresyonu, rezeksiyon bölgesi veya peritoneal yüzeyden olmaktadır. Peritoneal yayılan kanserlerde çoğunlukla ölüme peritoneal karsinomatozis sebep olduğu için, peritonun çıkarılması bu hastaların sağkalımına olumlu yönde etki edecektir. Buna ek olarak kemoterapötik ilaçların intraperitoneal olarak uygulanması ile tümör üzerinde direkt olarak yüksek ilaç konsantrasyonlarına ulaşılır. Hipertermik intraperitoneal kemoterapi, peritonektomi ve sitoredüktif cerrahi gerçekleştirildikten sonra peroperatif intraperitoneal kemoterapi uygulanmasıdır. Cerrahi ile rezidüel tümör dokusunu mikroskobik düzeye indirmek amaçlanmalıdır. Literatür bulguları gösteriyor ki sitoredüktif cerrahi ve hipertermik intraperitoneal kemoterapi kabul edilebilir toksisite oranları ile uygulanabilirdir. Morbidite ile ilişkili en önemli faktör, uygulanan barsak rezeksiyonu sayısı ve kemoterapötik ilacın serozal hasarın iyileşmesi üzerine olumsuz etkisi gibi görünmektedir. Sonuç olarak yapılan çalışmalara baktığımızda hipertermik intraperitoneal kemoterapi tedavisinin gelecekte over tümörleri ve peritoneal yüzeyel karsinomatoziste, primer veya sekonder olarak geniş uygulama alanı bulacağını düşünmekteyiz. Bu konuda ki deneyimimiz son derece kısıtlı olmasına rağmen gelecek için umutlu bir yöntem olduğunu ifade edebiliriz. Ancak yöntemin uygulanmasında tekonoloji gereği, operasyonu uzun sürmesi, deneyimli mutidisipliner bir ekip ile çok iyi bir postoperatif bakım gerektiği unutulmamalıd

Anahtar Kelimeler

• HIPEC, Jinekolojik Onkoloji, Kanser, Kemoterapi

THE ROLE OF HIPEC THERAPY IN GYNECOLOGIC ONCOLOGIC SURGERY

Öz

Many types of cancer originate from the organs in the abdominal and pelvic regions, and they spread via 3 different routes: namely, hematogeneous, lymphatic and transcoelomic. The dissemination of the cancer tends to occur via the resection area or peritoneal surface in many patients. Because peritoneal carcinomatosis is the most common cause of death in malignancies disseminated via the peritoneal route, removal of the peritoneum will have a positive impact on the survival of patients. Additonally, intraperitoneal instillation of chemotherapeutic medications reaches high concentrations with direct effect on the tumor. Hyperthermic intraperitoneal chemotherapy (HIPEC) refers to application of perioperative chemotherapy following peritonectomy and cytoreductive surgery. Surgery should aim to reduce residual tumor burden to microscopic levels. The available literature reveals that cytoreductive surgery and HPEC can be performed within acceptable toxicity ratios. The most important factors with potential effect on morbidity appear to be the number of bowel resections and the adverse impact of chemotherapy on healing of the serosal damage. In conclusion, on the basis of available data in the literature, we believe that HIPEC treatment will have widespread utility in primary or secondary management of ovarian tumors and peritoneal superficial carcinomatosis in the future. Although we have quite limited experience on this topic, we can state that it is a promising method in the future. However, it should be noted that an experienced multi-diciplinary team providing excellent postoperative care is mandatory owing to the high technology required in application of this method and the relatively long duration of the surgery

Anahtar Kelimeler

• HIPEC, Gynecologic Oncology, Cancer, Chemotherapy

Kaynakça

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